-
Anesthesia Progress Jun 2023Scientific evidence has rarely, if at all, been reported in the literature demonstrating analytical confirmation of the physical compatibility and stability of...
OBJECTIVE
Scientific evidence has rarely, if at all, been reported in the literature demonstrating analytical confirmation of the physical compatibility and stability of glycopyrrolate and rocuronium combined. The purpose of this experiment was to determine if glycopyrrolate and rocuronium are physically compatible.
METHODS
Glycopyrrolate and rocuronium were combined in various containers, observed over a 60-minute period, and compared against positive and negative controls. Measured metrics included color change, precipitate formation, Tyndall beam test, turbidity, and pH. Statistical analyses were used to assess significance of data trends.
RESULTS
The combination of glycopyrrolate and rocuronium did not result in any color change, precipitate formation, a positive Tyndall beam test, or a significantly positive turbidity and did not result in any significant change in pH, regardless of container.
CONCLUSION
Per the protocol used in this study, glycopyrrolate and rocuronium were determined to be physically compatible.
Topics: Humans; Rocuronium; Glycopyrrolate
PubMed: 37379091
DOI: 10.2344/anpr-69-04-02 -
International Journal of Chronic... 2023Triple therapy to prevent exacerbations from chronic obstructive pulmonary disease (COPD) is associated with improved health compared to single and dual-agent therapy in...
Exacerbations and Real-World Outcomes After Single-Inhaler Triple Therapy of Budesonide/Glycopyrrolate/Formoterol Fumarate, Among Patients with COPD: Results from the EROS (US) Study.
PURPOSE
Triple therapy to prevent exacerbations from chronic obstructive pulmonary disease (COPD) is associated with improved health compared to single and dual-agent therapy in some populations. This study assessed the benefits of prompt administration of budesonide/glycopyrrolate/formoterol fumarate (BGF) following a COPD exacerbation.
PATIENTS AND METHODS
EROS was a retrospective analysis of people with COPD using the MORE Registry. Inclusion required ≥1 severe, ≥2 moderate, or ≥1 moderate exacerbation while on other maintenance treatment. Within 12 months following the index exacerbation, ≥1 pharmacy claim for BGF was required. Primary outcomes were the rate of COPD exacerbations and healthcare costs for those that received BGF promptly (within 30 days of index exacerbation) versus delayed (31-180 days) and very delayed (181-365 days). The effect of each 30-day delay in initiation of BGF was estimated using a multivariable negative binomial regression model.
RESULTS
2409 patients were identified: 434 prompt, 1187 delayed, and 788 very delayed. The rate (95% CI) of total exacerbations post-index increased as time to BGF initiation increased: prompt 1.52 (1.39-1.66); delayed 2.00 (1.92-2.09); and very delayed 2.30 (2.20-2.40). Adjusting for patient characteristics, each 30-day delay in receiving BGF was associated with a 5% increase in the average number of subsequent exacerbations (rate ratio, 95% CI: 1.05, 1.01-1.08; <0.05). Prompt initiation of BGF was also associated with lower post-index annualized COPD-related costs ($5002 for prompt vs $7639 and $8724 for the delayed and very delayed groups, respectively).
CONCLUSION
Following a COPD exacerbation, promptly initiating BGF was associated with a reduction in subsequent exacerbations and reduced healthcare utilization and costs.
Topics: Humans; Bronchodilator Agents; Glycopyrrolate; Formoterol Fumarate; Retrospective Studies; Drug Combinations; Metered Dose Inhalers; Pulmonary Disease, Chronic Obstructive; Double-Blind Method; Budesonide; Nebulizers and Vaporizers; Administration, Inhalation
PubMed: 37849918
DOI: 10.2147/COPD.S432963 -
American Journal of Respiratory and... Aug 2018There are no studies on withdrawal of inhaled corticosteroids in patients on long-term triple therapy in the absence of frequent exacerbations. (Randomized Controlled Trial)
Randomized Controlled Trial
Long-Term Triple Therapy De-escalation to Indacaterol/Glycopyrronium in Patients with Chronic Obstructive Pulmonary Disease (SUNSET): A Randomized, Double-Blind, Triple-Dummy Clinical Trial.
RATIONALE
There are no studies on withdrawal of inhaled corticosteroids in patients on long-term triple therapy in the absence of frequent exacerbations.
OBJECTIVES
To evaluate the efficacy and safety of direct de-escalation from long-term triple therapy to indacaterol/glycopyrronium in nonfrequently exacerbating patients with chronic obstructive pulmonary disease (COPD).
METHODS
This 26-week, randomized, double-blind, triple-dummy study assessed the direct change from long-term triple therapy to indacaterol/glycopyrronium (110/50 μg once daily) or continuation of triple therapy (tiotropium [18 μg] once daily plus combination of salmeterol/fluticasone propionate [50/500 μg] twice daily) in nonfrequently exacerbating patients with moderate-to-severe COPD. Primary endpoint was noninferiority on change from baseline in trough FEV. Moderate or severe exacerbations were predefined secondary endpoints.
MEASUREMENTS AND MAIN RESULTS
A total of 527 patients were randomized to indacaterol/glycopyrronium and 526 to triple therapy. Inhaled corticosteroids withdrawal led to a reduction in trough FEV of -26 ml (95% confidence interval, -53 to 1 ml) with confidence limits exceeding the noninferiority margin of -50 ml. The annualized rate of moderate or severe COPD exacerbations did not differ between treatments (rate ratio, 1.08; 95% confidence interval, 0.83 to 1.40). Patients with ≥300 blood eosinophils/μl at baseline presented greater lung function loss and higher exacerbation risk. Adverse events were similar in the two groups.
CONCLUSIONS
In patients with COPD without frequent exacerbations on long-term triple therapy, the direct de-escalation to indacaterol/glycopyrronium led to a small decrease in lung function, with no difference in exacerbations. The higher exacerbation risk in patients with ≥300 blood eosinophils/μl suggests that these patients are likely to benefit from triple therapy. Clinical trial registered with www.clinicaltrials.gov (NCT 02603393).
Topics: Administration, Inhalation; Adrenal Cortex Hormones; Aged; Bronchodilator Agents; Double-Blind Method; Female; Fluticasone-Salmeterol Drug Combination; Glucocorticoids; Glycopyrrolate; Humans; Indans; Male; Muscarinic Antagonists; Pulmonary Disease, Chronic Obstructive; Quinolones; Tiotropium Bromide; Treatment Outcome
PubMed: 29779416
DOI: 10.1164/rccm.201803-0405OC -
Actas Dermo-sifiliograficas May 2015Until quite recently, clinical guidelines and reviews on the treatment of hyperhidrosis advised against the use of systemic therapies based on their unacceptable adverse... (Review)
Review
Until quite recently, clinical guidelines and reviews on the treatment of hyperhidrosis advised against the use of systemic therapies based on their unacceptable adverse effects and a lack of evidence of usefulness. Numerous studies published over the past few years, however, have shown that, when used appropriately, these treatments are effective and in general have a favorable tolerability profile, making them an additional option for the treatment of hyperhidrosis, particularly for disease that is widespread, multifocal, or resistant to other treatments. In this review, the first of its kind, we examine the systemic therapies available for hyperhidrosis, including antihypertensives, psychoactive agents, and in particular oral anticholinergics, although none of these drugs are currently approved for this indication.
Topics: Antihypertensive Agents; Cholinergic Antagonists; Clinical Trials as Topic; Disease Management; Evidence-Based Medicine; Glycopyrrolate; Humans; Hyperhidrosis; Meta-Analysis as Topic; Off-Label Use; Psychotropic Drugs
PubMed: 25638324
DOI: 10.1016/j.ad.2014.11.012 -
International Journal of Chronic... 2018Long-acting muscarinic antagonists (LAMAs), along with long-acting β-agonists (LABAs), are the mainstay for treatment of patients with COPD. Glycopyrrolate, or... (Review)
Review
Long-acting muscarinic antagonists (LAMAs), along with long-acting β-agonists (LABAs), are the mainstay for treatment of patients with COPD. Glycopyrrolate, or glycopyrronium bromide, like other LAMAs, inhibits parasympathetic nerve impulses by selectively blocking the binding of acetylcholine to muscarinic receptors. Glycopyrrolate is unusual in that it preferentially binds to M over M muscarinic receptors, thereby specifically targeting the primary muscarinic receptor responsible for bronchoconstriction occurring in COPD. Inhaled glycopyrrolate is slowly absorbed from the lungs and rapidly eliminated from the bloodstream, most likely by renal excretion in its unmetabolized form, limiting the potential for systemic adverse events. Inhaled glycopyrrolate is a fast-acting, efficacious treatment option for patients with moderate-severe COPD. It improves lung function, reduces the risk of exacerbations, and alleviates the symptoms of breathlessness, which in turn may explain the improvement seen in patients' quality of life. Inhaled formulations containing glycopyrrolate are well tolerated, and despite being an anticholinergic, few cardiovascular-related events have been reported. Inhaled glycopyrrolate is thus of value as both monotherapy and in combination with other classes of medication for maintenance treatment of COPD. This review covers the mechanism of action of inhaled glycopyrrolate, including its pharmacokinetic, pharmacodynamic, and safety profiles, and effects on mucus secretion. It also discusses the use of inhaled glycopyrrolate in the treatment of COPD, as monotherapy and in fixed-dose combinations with LABAs and inhaled corticosteroid-LABAs, including a triple therapy recently approved in Europe.
Topics: Administration, Inhalation; Adrenergic beta-2 Receptor Agonists; Bronchodilator Agents; Europe; Glycopyrrolate; Humans; Muscarinic Antagonists; Pulmonary Disease, Chronic Obstructive; Quality of Life; Receptor, Muscarinic M2; Receptor, Muscarinic M3; Treatment Outcome
PubMed: 29928118
DOI: 10.2147/COPD.S162646 -
American Journal of Veterinary Research Aug 2022To evaluate the sedative and cardiopulmonary effects of various combinations of acepromazine, dexmedetomidine, hydromorphone, and glycopyrrolate, followed by anesthetic...
Sedative and cardiopulmonary effects of intramuscular combinations of hydromorphone, acepromazine, dexmedetomidine, and glycopyrrolate followed by intravenous propofol and inhalant isoflurane anesthesia in healthy dogs.
OBJECTIVE
To evaluate the sedative and cardiopulmonary effects of various combinations of acepromazine, dexmedetomidine, hydromorphone, and glycopyrrolate, followed by anesthetic induction with propofol and maintenance with isoflurane in healthy dogs.
ANIMALS
6 healthy adult female Beagles.
PROCEDURES
Dogs were instrumented for hemodynamic measurements while anesthetized with isoflurane. Two hours after recovery, dogs received 1 of 4 IM combinations in a crossover design with 1 week between treatments: hydromorphone (0.1 mg/kg) and acepromazine (0.005 mg/kg; HA); hydromorphone and dexmedetomidine (0.0025 mg/kg; HD); hydromorphone, acepromazine, and dexmedetomidine (HAD); and hydromorphone, acepromazine, dexmedetomidine, and glycopyrrolate (0.02 mg/kg; HADG). Sedation was scored after 30 minutes. Physiologic variables and cardiac index were measured after sedation, after anesthetic induction with propofol, and every 15 minutes during maintenance of anesthesia with isoflurane for 60 minutes (target expired concentration at 760 mm Hg, 1.3%).
RESULTS
Sedation scores were not significantly different among treatments. Mean ± SD cardiac index was significantly higher for the HA (202 ± 45 mL/min/kg) and HADG (185 ± 59 mL/min/kg) treatments than for the HD (88 ± 31 mL/min/kg) and HAD (103 ± 25 mL/min/kg) treatments after sedation and through the first 15 minutes of isoflurane anesthesia. No ventricular arrhythmias were noted with any treatment.
CLINICAL RELEVANCE
In healthy dogs, IM administration of HADG before propofol and isoflurane anesthesia provided acceptable cardiopulmonary function with no adverse effects. This combination should be considered for routine anesthetic premedication in healthy dogs.
Topics: Acepromazine; Anesthesia; Anesthetics; Animals; Cross-Over Studies; Dexmedetomidine; Dogs; Female; Glycopyrrolate; Heart Rate; Hydromorphone; Hypnotics and Sedatives; Isoflurane; Propofol
PubMed: 35973002
DOI: 10.2460/ajvr.22.06.0098 -
Skin Therapy Letter Mar 2019Hyperhidrosis is a condition characterized by excessive sweat production beyond which is physiologically necessary for thermal regulation. Affecting over 4.8% of the... (Review)
Review
Hyperhidrosis is a condition characterized by excessive sweat production beyond which is physiologically necessary for thermal regulation. Affecting over 4.8% of the United States population, studies have shown that severe primary hyperhidrosis interferes with daily activities and can be considered intolerable, negatively impacting a patient’s quality of life. Glycopyrronium tosylate is a topical anticholinergic agent that reduces sweat production by blocking the activation of acetylcholine receptors in peripheral sweat glands. In clinical trials, topical glycopyrronium tosylate, a pre-moistened cloth containing 2.4% glycopyrronium solution, was shown to be an effective, safe and non-invasive treatment for patients suffering from primary hyperhidrosis. This review examines the clinical trials of topical glycopyrronium tosylate and its role in primary hyperhidrosis. Glycopyrronium tosylate was recently US FDA-approved (as of June 2018) to manage patients with primary axillary hyperhidrosis.
Topics: Administration, Cutaneous; Cholinergic Antagonists; Clinical Trials as Topic; Glycopyrrolate; Humans; Hyperhidrosis
PubMed: 30970203
DOI: No ID Found -
Journal of the American Veterinary... Dec 2021To compare effectiveness of maropitant and ondansetron in preventing preoperative vomiting and nausea in healthy dogs premedicated with a combination of hydromorphone,...
Effectiveness of orally administered maropitant and ondansetron in preventing preoperative emesis and nausea in healthy dogs premedicated with a combination of hydromorphone, acepromazine, and glycopyrrolate.
OBJECTIVE
To compare effectiveness of maropitant and ondansetron in preventing preoperative vomiting and nausea in healthy dogs premedicated with a combination of hydromorphone, acepromazine, and glycopyrrolate.
ANIMALS
88 dogs owned by rescue organizations.
PROCEDURES
Dogs received maropitant (n = 29) or ondansetron (28) PO 2 hours prior to premedication or did not receive an antiemetic (31; control). Dogs were evaluated for vomiting, nausea, and severity of nausea (scored for 6 signs) for 15 minutes following premedication with hydromorphone, acepromazine, and glycopyrrolate.
RESULTS
A significantly lower percentage of dogs vomited after receiving maropitant (3/29 [10%]), compared with control dogs (19/31 [62%]) and dogs that received ondansetron (15/28 [54%]). A significantly lower percentage of dogs appeared nauseated after receiving maropitant (3/29 [10%]), compared with control dogs (27/31 [87%]) and dogs that received ondansetron (14/28 [50%]), and a significantly lower percentage of dogs appeared nauseated after receiving ondansetron, compared with control dogs. Nausea severity scores for hypersalivation, lip licking, hard swallowing, and hunched posture were significantly lower for dogs that received maropitant than for control dogs, and scores for hypersalivation, lip licking, and hard swallowing were significantly lower for dogs that received ondansetron than for control dogs.
CONCLUSIONS AND CLINICAL RELEVANCE
Oral administration of maropitant 2 hours prior to premedication with hydromorphone reduced the incidence of vomiting and the incidence and severity of nausea in healthy dogs. Oral administration of ondansetron reduced the incidence and severity of nausea but not the incidence of vomiting.
Topics: Animals; Dogs; Acepromazine; Analgesics, Opioid; Antiemetics; Dog Diseases; Glycopyrrolate; Hydromorphone; Nausea; Ondansetron; Quinuclidines; Vomiting
PubMed: 34914630
DOI: 10.2460/javma.21.02.0082 -
American Family Physician Sep 2019
Review
Topics: Administration, Cutaneous; Cholinergic Antagonists; Glycopyrrolate; Humans; Hyperhidrosis
PubMed: 31524358
DOI: No ID Found -
Cureus Nov 2020Introduction In most of the oral surgical procedures performed under local anesthesia, we often face a great difficulty while performing surgeries because of reduced...
Introduction In most of the oral surgical procedures performed under local anesthesia, we often face a great difficulty while performing surgeries because of reduced accessibility and visibility which is hampered by blood and saliva at the surgical site. Anticholinergic drugs like atropine sulphate and glycopyrrolate are commonly used as antisialogogue for patients undergoing a surgical procedure under general anesthesia with little or no side effects. Aims and objectives To evaluate and compare the antisialogogue effect of atropine sulphate and glycopyrrolate in patients undergoing minor oral surgical procedures. To compare the efficacy of these drugs when administered intramuscularly and to evaluate their effects on heart rate in patients undergoing minor oral surgical procedures. Materials and methods Thirty patients undergoing minor oral surgical procedure were selected for the study. The patients were randomly assigned to receive either 0.6 mg/ml of Atropine Sulphate or 0.2 mg/ml of Glycopyrrolate intramuscularly. Salivary secretion, heart rate and arterial pressure were noted pre-injection and 30 minutes after the administration of the drug. Results Atropine sulphate and glycopyrrolate were equally potent as an antisialogogue. There was a significant increase in heart rate 30 min after the administration of atropine sulphate, but there was no significant change in heart rate in glycopyrrolate group. Conclusion Intramuscular gycopyrrolate is safer than intramuscular atropine sulphate as an antisialogogue in minor oral surgical procedures under local anesthesia.
PubMed: 33409027
DOI: 10.7759/cureus.11780